Document Type: Case Report

Authors

Department of Forensic Medicine, Lady Hardinge Medical College, New Delhi, India

Abstract

Background: Boric acid (BA) is commonly used as pesticide, disinfectant and wood preservative. Its ingestion can cause serious organ damages resulting in death.
Case report: A 19 year old man was found dead with two empty packs of BA tablets in vicinity of his body. On autopsy examination, brownish stains along with right angle of mouth and right nostril were found. Stomach was damaged with hemorrhagic gastritis. All internal organs including liver, kidney, spleen and brain were congested. The toxicological analysis of viscera confirmed boron ion toxicity.
Discussion: Boric acid is a moderately toxic compound that is a mucosal corrosive agent affecting upper respiratory and gastrointestinal tracts. It can also act as a generalized cellular poison, and thus all end organs including liver, kidneys, brain and gastrointestinal tract are prone to its toxicity. Massive BA poisoning mostly occurs in adults as a result of suicide attempt. Early aggressive hydration and hemodialysis can prevent its mortality.
Conclusion: A dead body with erythematous rash, redness of skin, bluish green color of vomitus and fecal matter, corrosive changes in oral and nasal cavity and multiple organ damages can be highly suggestive of BA poisoning.
 
How to cite this article: Rani M, Meena MC. Multiple Organ Damage Due to Boric Acid Toxicity. Asia Pac J Med Toxicol 2013;2:157-9.

Keywords

How to cite this article: Rani M, Meena MC. Multiple Organ Damage Due to Boric Acid Toxicity. Asia Pac J Med Toxicol 2013;2:157-9.

Introduction

Boric acid (BA) is an odorless compound (H3BO3; 5.5% Boron) which can be used as pesticide, water softener and disinfectant. It is commercially available in form of borax-based white powders (sodium borate; Na2[B4O5(OH)4]·8H2O) (1). Majority of the deaths due to BA poisoning have occurred in infants, though documented cases of its toxicity due to precautionary regulations are rare nowadays (1-4). However, accidental and occupational exposure to BA is not uncommon as it is an active component in wood preservative, household cleaners, cosmetics, pharmaceutical preparations such as dusting powders, mouth washes, eye washes, and personal care products such as toothpastes. It is also used in high concentrations as pesticide (99% boric acid).

Most cases of BA poisoning have been reported to occur accidentally; while chronic occupational BA poisoning was not formerly uncommon in adults (5). Nonetheless, BA ingestion for suicidal purposes has been quite rare. In this paper, a fatal case of toxicity due to BA ingestion for suicidal attempt is reported. The mechanism of toxicity, minimum lethal dose, clinical features and autopsy findings in such cases are discussed.

Case report

A19 year old man was found dead in the morning of November 2005. Two open packs of BA tablets (each commercial package contains 50 to 100 tablets of 500-1000 mg) were recovered from the vicinity of his body.

According to the history of the case, it was revealed that he had been under psychiatric follow-ups and treatments due to behavioral disorder, and he had a previous suicide attempt. 

The body was transferred to the department of forensic medicine of Lady Hardinge Medical College. At first glance, intense cyanosis of the lips and nail beds were evident. On autopsy examination, inflammatory changes in the oral cavity and brownish stains along with right angle of mouth and right nostril were found. Stomach was damaged with hemorrhagic gastritis (Figure 1).

Figure 1. Haemorrhagic gastritis due to boric acid toxicity on autopsy examination

All internal organs including liver, kidneys, spleen and brain were congested (Figure 2). The toxicological analysis of viscera confirmed boron ion toxicity.